title: Longitudinal study of antimicrobial-resistant commensal Escherichia coli in the faeces of horses in an equine hospital.
abstract: The increasing prevalence of antimicrobial resistance in bacteria represents a considerable problem for human and veterinary medicine, causing complications in the treatment of infections. Resistance in Escherichia coli from horses has been documented in commensal and pathogenic strains, but little information exists regarding the prevalence of such bacteria in hospitalised horses or associated risk factors. A longitudinal cohort study was conducted of 103 horses admitted to a referral equine hospital for more than 48 h, with faecal samples collected on hospital admission and subsequently every two days until discharge. Horses undergoing radioactive gamma scintigraphic examination, un-weaned foals and mares with un-weaned foals were excluded. Data were collected from enrolled animals, including antimicrobial treatment history and hospitalisation details. Samples were cultured for resistant E. coli; isolates had their antimicrobial resistance profile determined. High sample prevalence for resistant E. coli was identified for all antimicrobials examined except co-amoxiclav. The prevalence of resistance was consistently lower at admission, rising to a peak 4 days post-admission. Risk factors were analysed using multilevel, multivariable modelling, which identified significant clustering of resistance outcomes within horses. For all outcomes except trimethoprim resistance, the day the sample was obtained was significant, with increased risk of resistance for samples taken on day 2 or later. Antimicrobial treatment in the previous seven days and increased total daily dosages of cotrimoxazole prescribed in the hospital in the previous 24-48 h were associated with increased risk. Location within the hospital and admission reason were significant risk factors for some resistance outcomes. High levels of multidrug-resistant E. coli (47.7% of samples) and extended spectrum β-lactamase-producing E. coli (27.3% of samples) were recovered; such bacteria could significantly complicate treatment if they were the cause of infection and may represent a risk to personnel in close contact with hospitalised horses.
authors.affiliation: National Centre for Zoonosis Research, School of Veterinary Sciences, Leahurst Campus, University of Liverpool, CH64 7TE, UK. Thomas.Maddox@liverpool.ac.uk
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Maddox
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Williams
authors.forename: Peter D
authors.initials: PD
authors.lastname: Clegg
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: O'Donnell
authors.forename: Susan
authors.initials: S
authors.lastname: Dawson
authors.forename: Gina L
authors.initials: GL
authors.lastname: Pinchbeck
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology*; D005260:Female; D006734:Horse Diseases / Q000453:epidemiology / Q000382:microbiology*; D006736:Horses; D006762:Hospitals, Animal; D008297:Male
chemical_list: D000900:Anti-Bacterial Agents